Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 19656 | PR |
Y | 2084N0402X | Child Neurologist | A156650 | CA |
NPI | 1265847479 |
---|---|
Provider Name | Mrs. Maria Pia Grant-Tejada |
First Address | Los Angeles, CA 90095-5631 |
Second Address | Los Angeles, CA 90095-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2014 |
Last Update Date | 23/07/2021 |